The 2013 State Health Improvement Plan: Presentation to the State Coordinating Council

1. The 2013State Health Improvement Plan:Presentation to theState Coordinating Council Dec. 13, 2012

2. State Health Planning History • 1976:  Federally recognition of Dept. of Human Services as State agency with responsibility to conduct statewide health planning. • 1997:  DHHS shall adopt a State Health Plan that addresses “health care, facility and human resources needs in the state.” • 2003:  Governor’s Office of Health Policy & Finance established and required to issue a bi-annual  state health plan    • 2004-2010:  GOPHF collaborates with DHHS to issue 3 biannual state health plans (2006, 2008, 2010) • 2011:  DHHS endorses Maine CDC plan to seek national accreditation. State Health Improvement Plan part of Public Health Accreditation Board standards SCC presentation of the SHIP process

3. The “New” State Health Improvement Plan Driven by Public Heath Accreditation PHAB standards require: • Statewide health priorities, • Measureable objectives, • Improvement strategies, • Performance measures with measurable and time-framed-targets SCC presentation of the SHIP process

4. The “New” State Health Improvement Plan Driven by Public Heath Accreditation PHAB standards require: • Broad participation of public health partners • Information from the State Health Assessment • Issues and themes identified by stakeholders • Identification of state assets and resources • A process to set priorities SCC presentation of the SHIP process

5. The “New” State Health Improvement Plan Driven by Public Heath Accreditation PHAB standards require: • Demonstrated implementation of the State Health Improvement Plan SCC presentation of the SHIP process

6. SHIP Roles and Responsibilities • Maine CDC is the lead as the agency being accredited. • Building on partnerships with others in the state. • The SCC serves in advisory capacity to the process. SCC presentation of the SHIP process

7. SHIP Roles and Responsibilities • Priorities selected may give Maine CDC direction, but may not override legislative mandates and commitments via federal funding. • We hope these priorities will also inform our partners for their priority setting and planning. SCC presentation of the SHIP process

8. What does it mean to be a SHIP priority? • Maine CDC focus, based on available resources. • Potential focus for work with partners, with Maine CDC taking a lead role. • Careful tracking of performance during the implementation of the SHIP, to hold us accountable. SCC presentation of the SHIP process

9. SHIP Time Frame • PHAB standards state 3-5 years. • In 2016, the the State Health Assessment will be re-done in conjunction with the Community Health Needs Assessment (CHNA) required of non-profit hospitals by IRS regulations. • We anticipate the next version of SHIP following after this – perhaps drawing on the CHNAs as a new input. SCC presentation of the SHIP process

10. SHIP Inputs The SHIP will be informed by: • The State Health Assessment • Healthy Maine 2020 • The State Public Health System Assessment (SPHSA) and the Local Public Health Systems Assessments (LPHSA) • Maine CDC’s Strategic Plan SCC presentation of the SHIP process

11. SHIP Inputs The SHIP will be informed by: • District Public Health Improvement Plans • This SCC meeting • An electronic survey for all public health stakeholders. • Feedback from DCCs via webinars • Subject matter expert input from Maine CDC staff and other public health partners SCC presentation of the SHIP process

12. District Health Indicators (previously) (Health status) State Public Health Systems Assessment (capacity) Healthy Maine 2020 (Health status goals) District Public Health Improvement Plans State Health Assessment (health status) State Health Improvement Plan (priorities, strategies, and action steps) SCC presentation of the SHIP process

13. Development Timeline SCC presentation of the SHIP process

14. Development Timeline SCC presentation of the SHIP process

15. Development Timeline SCC presentation of the SHIP process

16. Questions? SCC presentation of the SHIP process

17. Setting Criteria for Selecting Priorities SCC presentation of the SHIP process

18. Criteria setting • Many sets of criteria have been developed • Using the evidence-base: meta analysis by Los Angeles County Health Department* • Our goal is a manageable list of criteria to use. • Too many can be confusing, and lead to less adherence to the criteria. • Aiming for 6-8 total. *JD Gunzenhauser, KN Smith, JE Fielding, Quality Improvement Brief: Priority-setting in Public Health, Los Angeles County Dept. of Public Health SCC presentation of the SHIP process

19. Criteria Setting • Four “buckets” • Two select what issues to be addressed: • Two select how to address the selected issues • These criteria could also affect the best choice of priority issues. SCC presentation of the SHIP process

20. Criteria Setting • Issue selection criteria: • Generally: Effectiveness of Interventions • Generally: Feasibility of Implementation of Interventions • In more detail: Magnitude of the Public Health Issue (Quantitative) • In more detail: Other Factors Related to the Importance of the Public Health Issue (Qualitative) SCC presentation of the SHIP process

21. Criteria Setting • “Bucket #1” specific criteria (pick 2-3): • Percent of population at risk • Mortality rate, premature death rate, prevalence, incidence, Years of Potential Life Lost, or other measure of the impact on the population • Magnitude of measure disparity (#2) between various groups (e.g., county versus other county, state, or federal comparisons; comparisons between various groups) • Economic burden on the population SCC presentation of the SHIP process

22. Criteria Setting • “Bucket #2” specific criteria (pick 2-3): • A health inequity exists for the issue • Alignment with national, state or local health objectives, including organizational strategic goals • Public health has a clearly established role to address the issue • Extent of public concern on the issue – urgency of the problem SCC presentation of the SHIP process

23. Criteria Setting • “Bucket #2” specific criteria (pick 2-3): • Level of support from community members and other stakeholders • Impact on systems or health • Work on this issue is “mandated” by statute or other authority • Legal or ethical concerns related to the issue • Linkage to an environmental concern, including safety SCC presentation of the SHIP process

24. Criteria Setting • Step 1: Are there any possible important criteria missing? • Step 2: Narrowing down the criteria to 6-8 SCC presentation of the SHIP process

25. The State Health Assessment SCC presentation of the SHIP process

26. State Health Assessment Indicator Selection • Internal Maine CDC committee identified 17 indicator sets. (early 2011) • Broad SHA workgroup selected 168 indicators (mid 2011) • Organized and analyzed the data. (2012) SCC presentation of the SHIP process

27. Data Included • Health status, behavior, or determinant • Not public health capacity • Not a measure of policy or strategy • Example: physical activity, but not physical education mandate • High-level “summary” measure: • Captures the bigger picture • Example: infant mortality, but not neonatal or post-neonatal mortality SCC presentation of the SHIP process

28. Data Included • Existing data • Routinely collected • Will be available in the future. • Consistent with Maine CDC program requirements (existing analyses). SCC presentation of the SHIP process

29. Data Included: • 168 indicators in 22 topic areas: • Demographics • SES measures • General Health Status • Access • Health Care Quality • Environmental Health • Occupational Health • Emergency Preparedness SCC presentation of the SHIP process

30. Data included • 168 indicators in 22 topic areas: • Cardiovascular Health • Respiratory Health • Cancer • Diabetes • Physical Activity, Nutrition and Weight • Substance Abuse • Tobacco Use DCC presentation of the State Heath Assessment 0ctober/November 2012 SCC presentation of the SHIP process

31. Data Included: • 168 indicators in 22 topic areas: • Maternal and Child Health • (includes reproductive health, birth defects and children with special health needs) • Unintentional Injury • Intentional Injury • Mental Health • Oral Health • Immunization • Infectious Disease SCC presentation of the SHIP process

32. Data included Where possible and applicable: • County and public health district. • Gender, race, ethnicity, and age (state level only). • Some breakdowns by educational status, income, sexual orientation, depending on the data source (state level only). • Years may be aggregated in some cases. Excluded indicators with no reliable Maine data SCC presentation of the SHIP process

33. Data Limitations • Health status does not change quickly. • Most recent data is not “this year” • Some data have limited trends, due to changes in data collection or methodology • Some data required using multiple years, due to small numbers. • Some data is not available, due to small numbers, even after aggregating years SCC presentation of the SHIP process

34. Data Limitations • Significant differences are based on confidence intervals, which are not always available. • Some state and national data have different years available, and therefore are not comparable. • Some of the national data sources use different methodologies and therefore are not comparable. SCC presentation of the SHIP process

35. Data Limitations: Disparities • Language barriers may reduce survey responses • Some additional disparities may be extrapolated from the state data • Race & ethnicity • Gender, sexual orientation, age, income, education • Additional disparities are known from other reports (not analyzed in the SHA) • Rural/urban • Other Social determinants • Without additional resources, further analysis may be limited. SCC presentation of the SHIP process

36. Data Presentation • Tables available on the Maine CDC website : www.maine.gov/dhhs/mcdc/phdata/sha • Selected district data • Today’s summary • Other possible formats to be determined SCC presentation of the SHIP process

37. Data Presentation • The SHA summary: 158 indicators • A few indicators do not fit well into a single table • Some national comparisons included. • Some trends noted • Further data in tables on web. SCC presentation of the SHIP process

38. What about Healthy Maine 2020? • Still in draft form. • Expected to be released by the end of 2012. • Overlaps with the State Health Assesmsnet, with some difference: • Healthy Maine 2020 focuses on GOALS – where we hope to be in 2020, • Includes health status and some strategies • The State Health Assessment focuses on health status SCC presentation of the SHIP process

39. Selected State Data SCC presentation of the SHIP process

40. Maine’s Population • 2011: 1.328 million • 678,125 females • 650,063 males • 3.8% increase from 2000 to 2010 • 43.1 people per square mile (2010) SCC presentation of the SHIP process

41. Maine’s Population SCC presentation of the SHIP process

42. Maine’s Population SCC presentation of the SHIP process

43. Maine’s Population SCC presentation of the SHIP process

44. Maine’s Population SCC presentation of the SHIP process

45. Socio-economic factors SCC presentation of the SHIP process

46. Re-visiting Bucket 1 Criteria:Percent of Population at Risk • Flu vaccines • Breast-feeding at 6 months • Unintended births • No dental care in the last year • Fruit and vegetable consumption – adults & youth • Physical activity – youth • Overwt & Obesity – adults • Illicit drug use - youth SCC presentation of the SHIP process

47. Re-visiting Bucket 1 Criteria:Mortality rates (Leading causes of death) SCC presentation of the SHIP process

48. Re-visiting Bucket 1 Criteria:Years of Potential Life Lost (YPLL) SCC presentation of the SHIP process

49. Re-visiting Bucket 1 Criteria:Federal Comparisons SCC presentation of the SHIP process

50. Re-visiting Bucket 1 Criteria:Another measure: direction of the trend • Pap smears • High blood pressure • High cholesterol • Diabetes ED visits • Pertussis • Lyme • Chlamydia • Gonorrhea • TBI ED visits • Fall-related ED visits • Poisoning deaths • Children with special health needs • Birth control pill use – HS students • Overwt – HS students • Obesity – adults • COPD hospitalizations SCC presentation of the SHIP process